Inside Health

Restless Legs: Uncomfortable and Overlooked

By ANAHAD O'CONNOR

Published: May 25, 2004

Millions of Americans suffer from restless legs syndrome, but few receive proper diagnoses, according to a new study.

At least 12 million Americans suffer from the syndrome, which causes sometimes painful throbbing and tingling in the legs. Yet despite the prevalence of the condition, few patients know what is wrong, and doctors rarely diagnose it, the study found.

The symptoms often strike at night and can lead to insomnia, chronic daytime fatigue and depression.

"Even in people who have the most severe and most frequent symptoms, the disease is ignored because doctors don't pick up on the signs," said Dr. Wayne Hening, a clinical assistant professor of neurology at Robert Wood Johnson Medical School in New Brunswick, N.J., and the lead author of the report. "There just isn't enough information for the primary care physician to spot the symptoms and make the diagnosis."

The new study, published online today by the journal Sleep Medicine, surveyed 23,052 people and 182 primary care physicians over a two-week period. The survey was financed by GlaxoSmithKline, which has a drug to treat restless leg syndrome in clinical trials.

About 1 in 10 people who answered the questionnaire reported symptoms of restless legs syndrome at least once a week. The researchers then looked at a subgroup that reported symptoms at least twice a week. Nearly 65 percent of these chronic sufferers said that they had seen a doctor about their symptoms, but the condition was diagnosed in less than 13 percent.

Asked about the impact of the symptoms on their quality of life, most subjects said it was significant. About 70 percent of the chronic sufferers said it took them an average of 30 minutes to fall asleep each night and 60 percent said they awoke at least three times a night.

The sleep disturbances caused by the syndrome also appeared to take a toll on the participants' everyday lives. Nearly half the chronic sufferers said they often had trouble concentrating the next day; a similar percentage reported a tendency to become depressed.

Dr. Ray L. Watts, a neurologist who was not involved with the study, said many doctors failed to diagnose the disease because patients have trouble describing its symptoms.

"Most people say they have an unpleasant or creepy-crawling feeling in their legs that only with further questioning can you recognize as R.L.S.," said Dr. Watts, who is chairman of the department of neurology at the University of Alabama, Birmingham. "More often than not, doctors misdiagnose it in the early stages or mistake it for something else. Sleep specialists and neurologists can spot it, but often general practitioners don't know what questions to ask."

With just a few questions, Dr. Watts said, a doctor can diagnose or rule out the disease in a matter of minutes. People who do have it, he said, find that it is usually most severe at night or while sitting or lying down. Getting up and moving the legs usually provides temporary relief. A lack of sleep is a hallmark of the disease, he said.

There is no approved treatment for restless legs syndrome in the United States, but several medications prescribed for Parkinson's disease and epilepsy are known to ease symptoms.

Avoiding certain substances and stimulants, like nicotine, can also help, Dr. Hening said.